2014-15 HWC Healthy Workplace Manage Stress
Campaign Partnership Meeting
Brussels, April 8 2014
Impact of stress and psych...
Main Questions
• Is stress at work a real challenge to
working populations across Europe?
• What is the scientific evidenc...
Work …
 provides a source of regular income and related
opportunities
 provides a source of personal growth and training...
 Increase of work pressure, pace of work,and competition,
including ‘high power work organization’ (impact of economic
gl...
Increased pressure of rationalisation
(mainly due to wage competition)
Downsizing, Merging, Outsourcing
Work Job Low wage ...
Increase in work intensity 2004-2010:
European Social Survey, 19 EU countries
Source: Gallie D (Ed.) (2013) ESS Topline Re...
Job insecurity 2004-2010
European Social Survey, 19 EU countries
Source: Gallie D (Ed.) (2013) ESS Topline Results Series ...
2. Question: What is the scientific evidence linking
stress at work with adverse health?
Stress occurs if a person is expo...
negative
emotions
stress responses
allostatic load
stress-related
disorders
Working conditions as chronic stressors:
How t...
 Demand-control model
(R. Karasek, 1979;
R. Karasek & T. Theorell, 1990)
 Effort-reward imbalance model
(J. Siegrist, 19...
active
passive
low
distress
high
distress
Quantitative demands
Scopeo low high
lowhigh
The demand-control model
(R. Karase...
effort
reward
demands / obligations
- labour income
- career mobility / job security
- esteem, respect
motivation
(‘overco...
Mean level of work stress in 17 European countries
(SHARE, ELSA, n = 14 254, aged 50-64)
Source: T. Lunau et al. (2013): U...
Social gradient of work stress
0
5
10
15
20
25
30
35
40
Effort-Reward Imbalance Low control
Percenthighstressed
Very low
L...
• Depression:
• ~ 30 studies (Europe, USA, Canada, Japan):
People exposed to stress at work: mean increase of relative
ris...
0,5
1
1,5
2
2,5
1 2 3 1 2 3
High demand / low control
Source: Based on Kivimäki, M, et al. (2002), BMJ, 325: 857, doi:/10....
Psychosocial stress at work and depressive symptoms: 13.128
employed men and women 50-64 yrs. from 17 countries in three
c...
3. Question: What can be done at organizational level
to manage stress and improve healthy work?
• Provide evidence of a b...
 Personal level: Stress prevention programs
 Interpersonal level: Leadership training;
communication skills;
 Structura...
Personal level: Effects of worksite stress
prevention programs: Meta-analysis
Source: D Montano et al. (2014) Scand J Work...
Source: T. Theorell et al. (2001), Psychosom Med, 63: 724-733.
Intervention group Control group
Baseline
390.4
6.2
After 1...
Variable
Demand
Control
Social support
Reward
Effort-reward imbal.
Work-rel. burnout
Means at t2 adj. for t0
experimental ...
1. Employment security
2. Selective hiring of new personnel
3. Self-managed teams; decentralization of decision
making
4. ...
Productivity and quality
of outcomes
Health and wellbeing of
employees
Client satisfaction
Workplace/-environment
Investme...
Thank you!
Impact of stress and psychosocial risks on health and performance-  Evidence at the organizational level
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Impact of stress and psychosocial risks on health and performance- Evidence at the organizational level

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2014-15 HWC Healthy Workplace Manage Stress
Campaign Partnership Meeting
Brussels, April 8 2014
Impact of stress and psychosocial risks on health and performance-
Evidence at the organizational level

Johannes Siegrist
Senior Professor of Workstress Research
University of Duesseldorf, Germany

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Impact of stress and psychosocial risks on health and performance- Evidence at the organizational level

  1. 1. 2014-15 HWC Healthy Workplace Manage Stress Campaign Partnership Meeting Brussels, April 8 2014 Impact of stress and psychosocial risks on health and performance- Evidence at the organizational level Johannes Siegrist Senior Professor of Workstress Research University of Duesseldorf, Germany
  2. 2. Main Questions • Is stress at work a real challenge to working populations across Europe? • What is the scientific evidence linking stress at work with adverse health? • What can be done at organizational level to manage stress and improve health at work?
  3. 3. Work …  provides a source of regular income and related opportunities  provides a source of personal growth and training of capabilities/competencies  provides social identity, social status and related rewards  enables access to social networks beyond primary groups  Impacts on personal health and well being by exposure to material and psychosocial stressors Importance of work for health
  4. 4.  Increase of work pressure, pace of work,and competition, including ‘high power work organization’ (impact of economic globalization)  High demand for flexibility, mobility, and adaption of workers to new taks/technologies  Fragmentation of occupational careers, de-standardized or atypical work, and growing job instability/insecurity  Increase of service and IT professions/occupations with high psychomental/emotional workload  Segmentation of labour market; social inequalities in quality of work and employment Significant changes in the nature of work and labour market
  5. 5. Increased pressure of rationalisation (mainly due to wage competition) Downsizing, Merging, Outsourcing Work Job Low wage / intensification insecurity salary Effects of economic globalisation: Labour market consequences in developed countries
  6. 6. Increase in work intensity 2004-2010: European Social Survey, 19 EU countries Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey
  7. 7. Job insecurity 2004-2010 European Social Survey, 19 EU countries Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey
  8. 8. 2. Question: What is the scientific evidence linking stress at work with adverse health? Stress occurs if a person is exposed to a threatening demand (stressor) that taxes or exceeds her/his capacity of successful response  risk of loss of control Dimensions of stress reactions: • Cognitive appraisal (evaluation of threat) • Affective response (anxiety, anger) • Activation of stress axes in organism (SAM, HPA) • Behavioural reaction (fight or flight) (restricted option!) Critical for health: • Chronic stressors requiring active coping  allostatic load;  risk of stress-related disorders (depression, CHD)
  9. 9. negative emotions stress responses allostatic load stress-related disorders Working conditions as chronic stressors: How to identify ‘toxic’ components within complex environments?
  10. 10.  Demand-control model (R. Karasek, 1979; R. Karasek & T. Theorell, 1990)  Effort-reward imbalance model (J. Siegrist, 1996; J. Siegrist et al., 2004)  Organizational injustice model (J. Greenberg, 1990; M. Elovainio et al., 2002)  Focus on job task profile: high demand/low control  Focus on work contract: high effort/low reward  Focus on unfair procedures and interactions Chronic psychosocial stress at work: Complementary stress-theoretical models
  11. 11. active passive low distress high distress Quantitative demands Scopeo low high lowhigh The demand-control model (R. Karasek 1979; R. Karasek & T. Theorell 1990) Psychometric scale of demand-control model: www.jcqcenter.org
  12. 12. effort reward demands / obligations - labour income - career mobility / job security - esteem, respect motivation (‘overcommitment‘) motivation (‘overcommitment‘) Extrinsic components Intrinsic component The model of effort-reward imbalance (J. Siegrist 1996) Psychometric scale of effort-reward model: www.uniklinik-duesseldorf.de/med-soziologie
  13. 13. Mean level of work stress in 17 European countries (SHARE, ELSA, n = 14 254, aged 50-64) Source: T. Lunau et al. (2013): Unpublished results .75 1 1.25 Mean ERI Hungary Portugal Czechia Poland Italy Estonia Slovenia England Spain France Germany Austria Belgium Denmark Netherlands Sweden Switzerland 3.5 4 4.5 5 Mean Low Control Poland Hungary Italy Czechia Spain Austria Estonia England France Germany Belgium Slovenia Portugal Switzerland Netherlands Sweden Denmark Psychosocial Working Conditions
  14. 14. Social gradient of work stress 0 5 10 15 20 25 30 35 40 Effort-Reward Imbalance Low control Percenthighstressed Very low Low Medium High Very high Source: Wahrendorf M et al. (2013) European Sociological Review 29: 792-802 The social gradient of work stress in the European workforce (age 50-64): SHARE-study
  15. 15. • Depression: • ~ 30 studies (Europe, USA, Canada, Japan): People exposed to stress at work: mean increase of relative risk: 80% = OR 1.8 (95% CI 1.1-3.1) • Coronary heart disease: • ~ 20 studies (Europe, USA): People exposed to stress at work: mean increase of relative . risk: 40% = OR: 1.4 (95% CI 1.2-1.6) • Additional evidence of elevated health risks: Metabolic syndrome / type II diabetes Alcohol dependence Musculoskeletal disorders Scientific evidence from prospective cohort studies: Demand-control and effort-reward-imbalance models Source: Steptoe A, Kivimäki M 2012. Nat Rev Cardiol.9 ; Stansfeld SA ,Candy B 2006 Scand J WEH 32: 443
  16. 16. 0,5 1 1,5 2 2,5 1 2 3 1 2 3 High demand / low control Source: Based on Kivimäki, M, et al. (2002), BMJ, 325: 857, doi:/10.1136/bmj.325.7369.857. High effort / low reward Tertile (work stress): 1 = no 2 = low 3 = high # adj. for age, sex, SEP, smoking, phys. act., SBP, cholest., and BMI * * Hazardratio# Work stress and cardiovascular mortality: Finnish Cohort Study, n = 812 employees
  17. 17. Psychosocial stress at work and depressive symptoms: 13.128 employed men and women 50-64 yrs. from 17 countries in three continents (SHARE, ELSA, HRS, JSTAR) 0 0,5 1 1,5 2 2,5 USA (N=1560) Europa (N=10342) Japan (N=1226) ERI Low control Source: J. Siegrist et al (2012) Globalization and Health 8:27. * * * * *
  18. 18. 3. Question: What can be done at organizational level to manage stress and improve healthy work? • Provide evidence of a business case • Provide shared commitment from management and employees • Provide available expertise (e.g. occupational safety & health) and equipment • Monitor working conditions and employees‘ health • Develop and implement programmes, invest in improvements, consult models of best practice • Ensure continuity, evaluate outcomes, build networks
  19. 19.  Personal level: Stress prevention programs  Interpersonal level: Leadership training; communication skills;  Structural level: Organizational/personnel development (based on work stress models)  Job enrichment/ enlargement (autonomy, control, responsibility)  Skill utilization / active learning  Participation / team work and social support  Culture of recognition  Fair wages/ gain-sharing  Continued qualification/ promotion prospects Develop and implement Healthy Workplace Programs
  20. 20. Personal level: Effects of worksite stress prevention programs: Meta-analysis Source: D Montano et al. (2014) Scand J Work Environ Health, doi: 10.5271/sjweh.3412 .
  21. 21. Source: T. Theorell et al. (2001), Psychosom Med, 63: 724-733. Intervention group Control group Baseline 390.4 6.2 After 1 year 345.2 6.1 Mean Cortisol (nmol/l) Mean decision latitude (range 2-8) Interaction group X time: *p = .05, **p = .02 Baseline 387.2 6.0 After 1 year 391.3 5.7 ** * Interpersonal level: Leadership training of managers and stress hormone excretion in subordinates
  22. 22. Variable Demand Control Social support Reward Effort-reward imbal. Work-rel. burnout Means at t2 adj. for t0 experimental - control hospital p 11.9 70.0 23.7 31.2 1.0 43.2 12.6 68.7 23.0 30.2 1.1 48.3 .008 .051 .011 .003 .001 .003 Source: R. Bourbonnais et al. (2011), Occup Environ Med, 68: 479-486. Structural – level: Organizational intervention in a Canadian hospital vs. control hospital* *36 month-follow-up, two Canadian hospitals, N=248 (intervention) vs. 240 (control hospital) (ANCOVA, adj. for baseline values)
  23. 23. 1. Employment security 2. Selective hiring of new personnel 3. Self-managed teams; decentralization of decision making 4. Comparatively high compensation contingent on performance 5. Extensive training 6. Reduced status distinctions and barriers 7. Extensive sharing of financial and performance information Source: J. Pfeffer (1998). The Human Equation: Building Profits by Putting People First. Boston: Harvard Business School. Seven practices of successful organizations: Reconciling health promotion with economy!
  24. 24. Productivity and quality of outcomes Health and wellbeing of employees Client satisfaction Workplace/-environment Investments into good quality of work The Sirdal Model of Improved Work
  25. 25. Thank you!

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